There are at present over 1 lakh individuals who are infected with HIV in Kerala state. The site of the study was CalicutMedicalCollege , an apex institution situated in the northern district of Kozhikode (Calicut) in Kerala. It is interesting to note that the institution caters to 4 districts of northern Kerala namely Kozhikode, Malapurram, Wayanad and Kannur. Thus the sample utilized in the study will be a representative sample of northern Kerala There was a need to draw priorities for hospitalization as the resources were limited in the tertiary care facility where the study was conducted. At present the HIV infected individuals were being admitted in the infectious disease ward where chances of hospital acquired and cross infection are high. The study also helped understand certain epidemiological aspects pertaining to the infection in north Kerala.
To identify the causes of hospitalization in HIV infected patients attending to a tertiary care center.
Observational descriptive study. The site of the study was Calicut Medical College, an apex institution situated in the northern district of Kozhikode (Calicut) in Kerala. It is interesting to note that the institution caters to 4 districts of northern Kerala namely Kozhikode, Malapurram, Wayanad and Kannur. Thus the sample utilized in the study will be a representative sample of northern Kerala
The study results revealed 20% admissions due to symptoms of Fever, breathlessness and weight loss. The major diagnosis was found to be tuberculosis in 34.2% of patients. PCP Pneumonia and HIV dementia was next common diagnosis with 13.15%.The other causes included oesophageal candidiasis,Cryptococcal diarrhea,Toxoplasmosis, Leishmaniasis , Herpes zoster and Nonhodgkins Lymphoma.
Positive associations were noted between tuberculosis infection and cd4 count below 200 (p value=0.017). 63.3% of the patients were migrants with history of work in states of increased HIV prevalence like Maharashtra, Karnataka and Tamil Nadu .
Some epidemiological data obtained in relation to the study were as follows: 76.7% of subjects divulged facts of their promiscuous sexual habits. The condom usage was observed to be nil. 16.7% revealed history of drug abuse of which 80% by intravenous route.71.4% reported associations with commercial sex workers.66.7% of subjects were married and 29.6% of subjects had HIV positive partners.
The major discharge diagnosis was tuberculosis in 34.2% of the patients, this could be related to the fact that the prevalence of tuberculosis is high in India. Positive associations were noted between tuberculosis infection and cd4 count below 200 (p value= 0.017). All these findings point to the need for tackling the issue of tuberculosis. The symptomatic patients with cd4 count 200 should be prioritized for isolation and vigilance for tuberculosis should be maintained for retro positive patients attending Anti-Retro Viral Clinic with cd4 count < 200 regardless of symptoms as this will help in early management. Other wise most of these individuals return as in- patients in terminal condition.
The usage of protective methods specifically condoms was nil as per the study this signals to the increased need for initiatives for education on condom use and promotion of safe sex. Efforts have to be directed to find out the reason that is preventing condom use among north Kerala population. The study showed 63.3% of subjects with positive travel/ work history. Being a state of high migrant population efforts needed to be centered on education of prospective migrants and counseling of symptomatic returnees directing them for retro –viral testing.
One important revelation with regards to the marital status of the subjects was the fact that 66.7% were married. The focus of attention of awareness programs targeting adolescents and single status may have to shift. As a wider picture emerges from the study new initiatives giving importance to promotion of safe sex is needed.